Patchy treatment for drug users

9th September 2006

A national review by the Healthcare Commission and the National Treatment Agency for Substance Misuse (NTA) says drug treatment services are getting better; however more needs to be done to reduce variations in care across the country.

The joint review of substance misuse services looked at whether the 149 drug action teams (DATS) prescribe drugs safely and appropriately, as well as plan treatment and coordinate services well.

DATs are made up of people from NHS trusts, social services, the police, the probation service, and the voluntary sector.

Services in general were found to be improving, but less than a third of dedicated action teams provided a good or excellent service. In all, 5% of DATs were rated as excellent, 23% as good, 71% as fair and 1% as weak.

The report said DATs still needed to tackle a range of problems;

Keep service users in treatment longer; drug treatment takes time and research has shown that service users are likely to get a better outcome if they remain in treatment for at least 12 weeks. The report showed there have been widespread improvements but a minority of DATs were ‘weak’ on these measures.

Improve methadone prescribing; Heroin users are often prescribed methadone as part of their treatment. The majority (95%) of services have good policies on methadone prescribing, but some services are still prescribing insufficient doses to maintain users and prevent the use of street drugs. Prescribing needs to be linked to individual need and there is a call for closer supervision in the early stages of treatment.

Involve service users more; Thirty-seven per cent of DATs scored ‘good’ or ‘excellent’ for supporting user involvement and 7% scored poorly, suggesting that some systems are much better developed than others.

The review also found not enough people who use drug treatment services have individual care plans and almost three quarters of services were weak when it came to assessing and managing the risks for patients.

The report also found that local drug partnerships, including primary care trusts (PCTs), need to improve their commissioning of drug treatment, including substitute prescribing.

However, more people are now using drugs services. Approximately 160,000 people joined treatment programmes in 2004/05, compared with 85,000 in 1998/99 - a rise of 89%. Waiting times for treatment have also fallen from an average of 9.1 weeks in December 2001 to 2.4 weeks in September 2005.

Anna Walker, the Healthcare Commission’s Chief Executive, said: “The number of problem drug users accessing treatment has increased dramatically in recent years, and that is good news. However, we now need to focus on improving quality. It is important that service users get the best treatment wherever they are and that they are encouraged to stay in treatment long enough to stabilise their condition."

Paul Hayes, the NTA’s Chief Executive said: “Drug dependency is concentrated amongst the most vulnerable people living in England and most disadvantaged communities. Twice as many people now have access to drug treatment as in 1998 and the experience of most of those in treatment is that the quality of the treatment they receive is improving. However this review clearly demonstrates that in some places, local partnerships and health providers are failing to deliver the high quality of care needed to help people turn their lives around."